Tonsillectomy treatment in PANDAS, the state of art of the last twenty years

Abstract

Background: PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder associated with Streptococcal Infection) are heterogeneous syndromes identified as post-infectious complications regarding Central Nervous System with specific involvement of neuropsychiatric and behavioral skills. The various treatment strategies employed focus on elimination of inciting infectious agents (antibiotics), support of the immune system (intravenous immunoglobulin, IVIG), suppression of the autoimmune mechanism (IVIG, plasmapheresis, steroids), and/or direct treatment of psychiatric symptoms (antidepressants, anxiolytics, mood stabilizers). However, especially in the last 20 years, the surgical role of tonsillectomy / adenoidectomy has assumed greater importance in the scientific literature, although presenting conflicting results it has however been included in the list of treatments available for PANDAS. Material and methods: A structured search of the MEDLINE online database (time interval from 2000 to 2020) was undertaken. Keywords “PANDAS” were combined with “tonsillectomy”. The criteria for inclusion of citations were English language case reports and case series with confirmed and definitive cases of PANDAS according to the Institute of Mental Health Clinical Diagnostic Criteria for PANDAS. Discussion: We performed a mini review of the literature to evaluate the published evidence regarding surgical treatment (tonsillectomy) of PANDAS. We compared the main selected studies of the last twenty years on the subject, noting a progressive loss of importance of the use of the wide-ranging surgical method. Conclusions: Over the years, surgical treatment seems to have assumed a second level position in the main treatments of the disease. But in a multidisciplinary approach to the disease some patients can still benefit from this method. In the next future a multidisciplinary program must be tailored to a child’s specific needs.